Incidence of pregnancy-related acute kidney injury and associated perinatal and obstetric risk factors; a 5-year updated systematic review analysis from 2022 to 2026

Abstract

Introduction: Pregnancy-related acute kidney injury (PR-AKI) is a serious but potentially preventable complication that contributes to maternal and perinatal morbidity and mortality, particularly in low- and middle-income settings. Marked variation in reported incidence and underlying causes across regions suggests important differences in obstetric care and health-system performance. This systematic review study aimed to synthesize contemporary evidence on the incidence of PR-AKI and to identify the major obstetric and perinatal risk factors associated with its occurrence between 2022 and 2026. Methods and Materials: This systematic review included observational studies (cohort, case-control, and cross-sectional designs) reporting PR-AKI between 2022 and 2026 that were identified through a multi-database search supplemented by hand-searching reference lists. Data on study characteristics, PR-AKI incidence, and obstetric and perinatal risk factors were extracted in duplicate using a standardized form, and risk of bias was appraised with the Newcastle-Ottawa Scale. Given methodological and clinical heterogeneity, findings were synthesized narratively, with incidence estimates and major risk constellations summarized in tables. Results: Across 17 studies comprising 3,375 women, the reported incidence of PR-AKI showed marked heterogeneity, ranging from low rates in population-based cohorts in high-income countries to very high rates among high-risk obstetric populations and tertiary referral centres in low- and middle-income settings. Hypertensive disorders of pregnancy, particularly pre-eclampsia and eclampsia, together with sepsis and obstetric haemorrhage consistently emerged as the leading, and frequently overlapping, etiologic factors for PR-AKI. Conclusion: The PR-AKI remains a major yet largely preventable obstetric complication, with incidence varying markedly across health-care settings and strongest contributions from hypertensive disorders, sepsis, and obstetric haemorrhage. These results highlight an urgent need for health-system-level interventions that emphasize early identification and tight control of hypertensive disease in pregnancy, alongside universal access to skilled intrapartum care with effective prevention and management of bleeding and infection. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO (ID: CRD420261394310) and the Research Registry (UIN: reviewregistry2104) websites.